Clinical and necropsy findings are described in 3 patients who had rest angina pectoris, ST segment elevation on electrocardiogram during chest pain, coronary arterial spasm on angiogram and sudden death. Although significant "fixed" coronary narrowing i.e., that due to atherosclerotic plaques, was appreciated by angiogram in only 1 of the 3 patients, necropsy disclosed severe fixed coronary narrowings in all 3 patients, involving particularly the artery in which spasm had been demonstrated during life. Additionally, examination of each 5 - mm long segment of the coronary artery which had been spastic during life (2 patients) disclosed several focally spastic segments at necropsy, indicating that spasm persisted after death. Although most previously reported necropsy patients with Prinzmetal's angina had some fixed coronary narrowing, underlying fixed narrowing may be difficult to identify angiographically as demonstrated by our 3 patients.